Incidence and case fatality of aneurysmal subarachnoid hemorrhage admitted to hospital between 2008 and 2014 in Norway

Object. The purpose of this study was to assess the overall management and surgical outcome of primary intracerebral hemorrhage (ICH) and aneurysmal subarachnoid hemorrhage (SAH) among the 85,000 residents of Izumo City, Japan.Methods. During 1991 through 1996, 267 patients with ICH and 123 with SAH were treated in Izumo. Of the 267 patients with ICH, 25 underwent hematoma removal by open craniotomy or suboccipital craniectomy and 34 underwent stereotactic evacuation of the hematoma, whereas aneurysm clipping was performed in 71 of the 123 patients with SAH; operability rates were thus 22% for ICH and 58% for SAH (p < 0.0001). The overall 30-day survival rates were 86% for ICH and 66% for SAH (p < 0.0001) and the 2-year survival rates were 73% and 62% (p = 0.0207), respectively. In patients who underwent surgery, 30-day and 2-year survival rates were 93% for ICH and 100% for SAH (p = 0.0262), and 75% for ICH and 97% for SAH (p = 0.0002), respectively. In patients with ICH, the most important predictors of 30-day case-fatality rates were the volume of the hematoma, the Glasgow Coma Scale (GCS) score, rebleeding, and midline shifting, whereas those for 2-year survival were the GCS score, age, rebleeding, and hematoma volume. In patients with SAH, the most important determinants of 30-day case-fatality rates were the GCS score and age, whereas only the GCS score had a significant impact on 2-year survival.Conclusions. The overall survival rates for patients with ICH or SAH in Izumo were more favorable than those in previously published epidemiological studies. However, despite improved surgical results, the overall management of ICH and SAH still produced an unsatisfactory outcome, mainly because of primary brain damage.

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Prediction of 60-day case fatality after aneurysmal subarachnoid hemorrhage: external validation of a prediction model

Critical Care ◽

10.1186/cc14547 ◽

2015 ◽

Vol 19 (Suppl 1) ◽

pp. P467

Author(s):

S Dijkland ◽

B Roozenbeek ◽

P Brouwer ◽

H Lingsma ◽

D Dippel ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Prediction Model ◽

Aneurysmal Subarachnoid Hemorrhage ◽

External Validation ◽

Case Fatality ◽

Day Case

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Aneurysmal subarachnoid hemorrhage: long-term trends in incidence and survival in Olmsted County, Minnesota

Journal of Neurosurgery ◽

10.3171/2019.12.jns192468 ◽

2020 ◽

pp. 1-6

Author(s):

Enrico Giordan ◽

Christopher S. Graffeo ◽

Alejandro A. Rabinstein ◽

Robert D. Brown ◽

Walter A. Rocca ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Incidence Rate ◽

Case Fatality Rate ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Case Fatality ◽

Population Based ◽

Fatality Rate ◽

Olmsted County ◽

Day Case ◽

Incident Cases

OBJECTIVERecent population-based and hospital cohort studies have reported a decreasing incidence of aneurysmal subarachnoid hemorrhage (aSAH) and declining aSAH-associated case-fatality rates. Principal drivers of these trends are debated, but improvements in smoking cessation and hypertension control may be critical factors.METHODSThe population-based medical records linkage system of the Rochester Epidemiological Project was used to document aSAH incidence and 30-day case fatality rates during a 20-year study period (1996–2016) in Olmsted County, Minnesota. Incidence rates in the study period were compared with data from a previous Olmsted County study concerning aSAH incidence from 1965 to 1995 and with regional trends in tobacco use.RESULTSOne hundred nineteen incident cases of aSAH were included. The median age at hemorrhage was 59 years (range 16–94 years), and 74 patients were female (62.2%). The overall average annual aSAH incidence rate was 4.2/100,000 person-years (P-Y). The aSAH incidence rate decreased from 5.7/100,000 in 1996 to 3.5/100,000 P-Y in 2011–2016. The overall aSAH-associated 30-day case-fatality rate was 21.9% and declined by approximately 0.5% annually. An accelerated decline in the fatality rate (0.9%/year) was observed from 2006–2016. Smoking among adult Olmsted County residents decreased from 20.4% in 2000 to 9.1% in 2018.CONCLUSIONSA decline in the incidence of aSAH and 30-day case-fatality rate from 1996 to 2016 was observed, as well as an accelerated decline of the fatality rate from 2006 to 2016. These findings confirm and extend the trends reported by prior studies in the same population. The decrease in aSAH in the years studied paralleled a noticeable reduction in the population smoking rates.

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Magnetic resonance imaging and brain injury in the chronic phase after aneurysmal subarachnoid hemorrhage: A systematic review

International Journal of Stroke ◽

10.1177/1747493017730781 ◽

2017 ◽

Vol 13 (1) ◽

pp. 24-34 ◽

Cited By ~ 2

Author(s):

Bertine L Stehouwer ◽

Lisa A van der Kleij ◽

Jeroen Hendrikse ◽

Gabriel JE Rinkel ◽

Jill B De Vis

Keyword(s):

Systematic Review ◽

Subarachnoid Hemorrhage ◽

Brain Volume ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Brain Mri ◽

Chronic Phase ◽

Case Fatality ◽

Intracranial Volume ◽

Level Of Evidence ◽

Brain Infarcts

Background Case-fatality rates after aneurysmal subarachnoid hemorrhage have decreased over the past decades. However, many patients who survive an aneurysmal subarachnoid hemorrhage have long-term functional and cognitive impairments. Aims We sought to review all data on conventional brain MRI obtained in the chronic phase after aneurysmal subarachnoid hemorrhage to (1) analyze the proportion of patients with cerebral infarction or brain volume changes; (2) investigate baseline determinants predictive of MRI-detected damage; and (3) assess if brain damage is predictive of patient outcome. Summary of review All original data published between 1 January 2000 and 4 October 2017 was searched using the PUBMED, EMBASE, and Web of Science databases. Based on preset inclusion criteria, 15 from 5200 articles were included with a total of 996 aneurysmal subarachnoid hemorrhage patients. Quality assessment, risk of bias assessment, and level of evidence assessment were performed. The results according to aim, with levels of evidence, were: (1) 25 to 81% of aneurysmal subarachnoid hemorrhage patients show infarcts (strong); there is a higher ratio of cerebrospinal fluid-to-intracranial volume in patients compared to controls (strong); (2) there is a negative relation between age (moderate), DCI (low) and brain volume measurement outcomes; (3) lower brain parenchymal volume (strong) and the presence of infarcts or infarct volumes (moderate) are associated with a worse outcome. Conclusion Patients after aneurysmal subarachnoid hemorrhage may demonstrate brain infarcts and decreased brain parenchyma, which is related to worse outcome. Thereby, both brain infarcts and brain volume measurements could be used as outcome markers in pharmaceutical trials. Systematic Review Registration PROSPERO CRD42016040095

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Impact of intraventricular hemorrhage measured by Graeb and LeRoux score on case fatality risk and chronic hydrocephalus in aneurysmal subarachnoid hemorrhage

Acta Neurochirurgica ◽

10.1007/s00701-014-2334-z ◽

2015 ◽

Vol 157 (3) ◽

pp. 409-415 ◽

Cited By ~ 25

Author(s):

Patrick Czorlich ◽

Franz Ricklefs ◽

Matthias Reitz ◽

Eik Vettorazzi ◽

Tammam Abboud ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Intraventricular Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Case Fatality ◽

Chronic Hydrocephalus ◽

Fatality Risk ◽

Case Fatality Risk

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Hospital case-volume is associated with case-fatality after aneurysmal subarachnoid hemorrhage

International Journal of Stroke ◽

10.1177/1747493018790073 ◽

2018 ◽

Vol 14 (3) ◽

pp. 282-289 ◽

Cited By ~ 2

Author(s):

Antti Lindgren ◽

Sarah Burt ◽

Ellie Bragan Turner ◽

Atte Meretoja ◽

Jin-Moo Lee ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Treatment Modality ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Tertiary Care ◽

Case Fatality ◽

High Volume ◽

Day Case ◽

Case Volume ◽

Hospital Case ◽

Low Volume

Background Inverse association between hospital case-volume and case-fatality has been observed for various nonsurgical interventions and surgical procedures. Aims To study the impact of hospital case-volume on outcome after aneurysmal subarachnoid hemorrhage (aSAH). Methods We included aSAH patients who underwent aneurysm coiling or clipping from tertiary care medical centers across three continents using the Dr Foster Stroke GOAL database 2007–2014. Hospitals were categorized by annual case-volume (low volume: <41/year; intermediate: 41–70/year; high: >70/year). Primary outcome was 14-day in-hospital case-fatality. We calculated proportions, and used multiple logistic regression to adjust for age, sex, differences in comorbidity or disease severity, aneurysm treatment modality, and hospital. Results We included 8525 patients (2363 treated in low volume hospitals, 3563 treated in intermediate volume hospitals, and 2599 in high-volume hospitals). Crude 14-day case-fatality for hospitals with low case-volume was 10.4% (95% confidence interval (CI) 9.2–11.7%), for intermediate volume 7.0% (95% CI 6.2–7.9%; adjusted odds ratio (OR) 0.63 (95%CI 0.47–0.85)) and for high volume 5.4% (95% CI 4.6–6.3%; adjusted OR 0.50 (95% CI 0.33–0.74)). In patients with clipped aneurysms, adjusted OR for 14-day case-fatality was 0.46 (95% CI 0.30–0.71) for hospitals with intermediate case-volume and 0.42 (95% CI 0.25–0.72) with high case-volume. In patients with coiled aneurysms, adjusted OR was 0.77 (95% CI 0.55–1.07) for hospitals with intermediate case-volume and 0.56 (95% CI 0.36–0.87) with high case-volume. Conclusions Even within a subset of large, tertiary care centers, intermediate and high hospital case-volume is associated with lower case-fatality after aSAH regardless of treatment modality, supporting centralization to higher volume centers.

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Computed Tomography Angiography Spot Sign Does Not Predict Case Fatality in Aneurysmal Subarachnoid Hemorrhage With Intraparenchymal Extension

Stroke ◽

10.1161/strokeaha.111.000586 ◽

2013 ◽

Vol 44 (6) ◽

pp. 1590-1594 ◽

Cited By ~ 6

Author(s):

H. Bart Brouwers ◽

Daan Backes ◽

W. Taylor Kimberly ◽

Kristin Schwab ◽

Javier M. Romero ◽

...

Keyword(s):

Computed Tomography ◽

Subarachnoid Hemorrhage ◽

Computed Tomography Angiography ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Case Fatality ◽

Spot Sign

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Higher mean arterial pressure increases risk of in-hospital mortality in aneurysmal subarachnoid hemorrhage

Zinc supplementation improves heme biosynthesis in rats exposed to lead ◽

10.18051/univmed.2020.v39.153-161 ◽

2020 ◽

Vol 39 (3) ◽

pp. 153

Author(s):

Nadya Noor Ramadhania ◽

Ahmad Faisal Darmawan ◽

Achmad Firdaus Sani

Keyword(s):

Logistic Regression ◽

Subarachnoid Hemorrhage ◽

Mean Arterial Pressure ◽

Mortality Rate ◽

Arterial Pressure ◽

Hospital Mortality ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Case Fatality ◽

Hospital Death ◽

Aneurysm Treatment

Background The majority (80%) of spontaneous subarachnoid hemorrhage (SAH) cases are caused by cerebral aneurysm rupture. The reported case fatality rate of aneurysmal SAH is still as high as 25 to 50%. Even though studies on aneurysmal SAH have been conducted, the mechanism and factors contributing to its mortality have not yet been clearly understood. The present study aimed to determine the predictors of mortality in aneurysmal SAH. Methods This was an observational analytic cross-sectional study. Data of 264 patients with aneurysmal SAH was obtained retrospectively from the medical records. Age, degree of consciousness, blood pressure, absence of aneurysmal treatment and mortality were collected. The simple and multiple logistic regression were used to analyze the data. Results The in-hospital mortality rate of aneurysmal SAH was still very high, with 140 (53.1%) patients dying during hospitalization. Simple logic regression analysis showed that patients with older age, lower Glasgow Coma Scale (GCS) score, higher mean arterial pressure (MAP) and no aneurysm treatment had higher in-hospital mortality risk. However, multivariate logistic regression showed that the strongest in-hospital mortality predictor was higher MAP (aOR 2.29; p=0.025), while younger age (aOR 0.39; p=0.006) and aneurysm treatment (aOR 0.34; p=0.006) were independent protective factors against in-hospital death. Conclusion Patients with higher mean arterial pressure on initial measurement had higher risks of mortality. More endovascular neurointervention facilities are needed to decrease the mortality rate of aneurysmal SAH.

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Incidence and Outcome of Aneurysmal Subarachnoid Hemorrhage

Stroke ◽

10.1161/strokeaha.120.029538 ◽

2021 ◽

Vol 52 (1) ◽

pp. 344-347

Author(s):

Bawarjan Schatlo ◽

Christian Fung ◽

Martin N. Stienen ◽

Ali R. Fathi ◽

Javier Fandino ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Point Of Care ◽

Case Fatality ◽

Population Data ◽

Incidence Rates ◽

Modified Rankin Scale ◽

Unique Identifier ◽

Global Trend ◽

Independent Life

Background and Purpose: The purpose of this study was to assess nationwide incidence and outcomes of aneurysmal subarachnoid hemorrhage (aSAH). The Swiss SOS (Swiss Study on Subarachnoid Hemorrhage) was established in 2008 and offers the unique opportunity to provide this data from the point of care on a nationwide level. Methods: All patients with confirmed aneurysmal subarachnoid hemorrhage admitted between January 1, 2009 and December 31, 2014, within Switzerland were recorded in a prospective registry. Incidence rates were calculated based on time-matched population data. Admission parameters and outcomes at discharge and at 1 year were recorded. Results: We recorded data of 1787 consecutive patients. The incidence of aneurysmal subarachnoid hemorrhage in Switzerland was 3.7 per 100 000 persons/y. The number of female patients was 1170 (65.5%). With a follow-up rate of 91.3% at 1 year, 1042 patients (58.8%) led an independent life according to the modified Rankin Scale (0–2). About 1 in 10 patients survived in a dependent state (modified Rankin Scale, 3–5; n=185; 10.4%). Case fatality was 20.1% (n=356) at discharge and 22.1% (n=391) after 1 year. Conclusions: The current incidence of aneurysmal subarachnoid hemorrhage in Switzerland is lower than expected and an indication of a global trend toward decreasing admissions for ruptured intracranial aneurysms. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03245866.

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